Dental treatment affordability and oral outcomes among U.S. adults: NHANES 2015–2018

Despite the increase in dental care utilization in the U.S., access to dental care is limited by many barriers, particularly financial ones. The aim of this study was to assess the relationship between the affordability of dental treatment and oral health outcomes. This cross-sectional study utilized 2015–2018 National Health and Nutrition Examination Survey data (NHANES). The key outcomes measured included the number of decayed teeth, missed teeth due to caries, and filled teeth (DMFT), the number of untreated teeth with dental decay and missing teeth, the presence of root caries, and the affordability of dental care as the main predictor. Descriptive analyses, negative binomial analyses for count outcomes, and logistic regression for binary outcomes were conducted. The analyses were adjusted for the NHANES sampling weights. The study included 11,566 participants, 14.17% of whom reported being unable to afford dental treatment. Among those who could not afford dental treatment, the mean ratio was 3.27 (95% CI: 2.72–3.95; p < 0.01) for untreated dental decay, along with a higher DMFT (mean ratio 1.24; 95% CI: 1.18–1.31; p < 0.01) compared with those who could afford treatment. The odds of having root caries were significantly greater (odds ratio 4.46; 95% CI: 3.53–5.64; p < 0.01) among those unable to afford dental care than among those who could afford treatment. Individuals who cannot afford dental care experienced significantly higher ratios of untreated dental decay and other oral health outcomes. The findings highlight the necessity for targeted interventions to address financial barriers and improve access to dental services.